Medihub - Medical Information - Geriatric and healthcare of the elderly

Asthma in the Older Woman

Definition of asthma

1. Widespread narrowing of airways that changes in severity either spontaneously or as a result of treatment

2. A chronic inflammatory disorder of the airways in which many cells play a role. In susceptible individuals this inflammation causes symptoms which are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment, and causes an associated increase in airway responsiveness to a variety of stimuli.

Asthma is the 6^th ranking chronic condition in the US. Afflicts people of all ages and socioeconomic circumstances, and a major contributor to disability, family disruption and illness costs.

Is an older person susceptible to developing asthma?

Yes. This is due to several factors:

1. With age, there is increased cumulative exposure to environmental stimuli and other antigens.

2. 27-38% of adults with childhood asthma in remission develop recurrence after age 45 yr.

3. Those who develop the disease for the first time usually (40-50%) does so after age 65 yrs, but they also reported ‘respiratory trouble’ before age 16.

4. Prevalence of asthma increases from adolescence to older age.

Asthma in older women

Older women seem to be disproportionately affected:

Females Males

Prevalence: 60.2/1000 51.7/1000

Admission: 2.5 : 1

ALOS Longer Shorter

Actual reasons of why females are more affected by asthma are not clear, but could possibly be due to:

1. Old age itself

2. Increased risk through pregnancies which exposes them to foreign antigens

3. Asthma is thought to be triggered by a number of inflammation producing susbtances through immunologic mechanisms –women have higher prevalence of autoimmune disease

4. Anatomic structures smaller in women, including airway size.

5. Women, being home bound – exposed to indoor allergens including cockroach antigens, smoke, fumes, gases from stove, cleaning agents etc.

6. Hormonal factors – long term use of postmenopausal hormone therapy associated with 2 fold increased risk of subsequent asthma. This includes estrogen with or without progesterone.

7. Possibly gender bias in diagnosis – men – tend to be diagnosed as bronchitis, women – as asthma.

Challenges to diagnosis and treatment of asthma

1. Concomitant Chronic Obstructive Airway Disease

2. Chronic Heart Failure

3. Pulmonary embolism

4. Gastroesophageal reflux – very prevalent (45->80%) in adult asthmatics. Presenting with symptoms like substernal pain, or pressure, nocturnal cough or wheezing, it is a possible outcome for any patient with poorly controlled asthma.

5. Microaspiration of gastric contents into trachea – increase airway resistance

6. Iatrogenic factors caused by treatments of other diseases – beta blockers, ACE inhibitors, aspirin, NSAIDs